Use and safety of enteral nutrition protocols in acute care: A scoping review of literature and retrospective audit of practice

Abstract

AimStandardised enteral nutrition protocols are recommended in critical care, however their use and safety are not well described in other inpatient populations. This mixed methods study reports on the use and safety of enteral nutrition protocols for non‐critically ill adults.MethodsA scoping review of published literature was conducted. In addition a retrospective audit of practice at an Australian tertiary teaching hospital with an existing hospital‐wide standardised enteral nutrition protocol was performed. Data on use, safety and adequacy of enteral nutrition prescription were collected from medical records for patients receiving enteral nutrition on acute wards (January–March 2020).ResultsScreening of 9298 records yielded six primary research articles. Studies were generally low quality. Published literature suggested that protocols may reduce time to enteral nutrition initiation and goal rate, and improve adequacy of nutrition provision. No adverse outcomes were reported. From the local audit of practice (105 admissions, 98 patients), enteral nutrition commencement was timely (median 0 (IQR 0–1) days from request; goal rate: median 1 (IQR 0–2) days from commencement and adequate (nil underfeeding), without prior dietitian review in 82% of cases. Enteral nutrition was commenced per protocol in 61% of instances. No adverse events, including refeeding syndrome, were observed.ConclusionsMost inpatients requiring enteral nutrition can be safely and adequately managed on enteral nutrition protocols. Evaluation of protocols outside of the critical care setting remains a gap in the literature. Standardised enteral nutrition protocols may improve delivery of nutrition to patients, whilst allowing dietitians to focus on those with specialised nutrition support needs.

What does your university degree do for you? The role of academic dietitians in the development of the dietetics profession

“…By 2018, academic dietitians at the professorial level had a stronger research track record than other professional groups. 13 The research sophistication of the dietetics profession is reflected in the collection of papers in this edition of the journal, all of which are syntheses of the literature in the form of scoping reviews [15][16][17][18] or systematic reviews alone, 19 or with meta-analyses. 20,21 So after these decades of development, where is academic dietetics positioned as we enter 2024?…”